Although obesity among young people in the United States is a major problem, teen bariatric surgery is very uncommon. Minors represent only about one-half of 1 percent of all weight-loss surgery (WLS) patients. Fewer than 1,000 pediatric patients per year have a WLS procedure. However, a number of hospitals are currently gathering data in a Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study funded by the National Institutes of Health (NIH). This research study will follow post-WLS teens long term and learn more about risks and benefits for pediatric patients. As of 2013, this study is still ongoing.
What Types of Bariatric Surgery Are Offered to Teens?
Three of the four major types of WLS performed on adults are also approved for pediatric patients in the United States. These are:
Gastric Bypass (Roux-En-Y)
This is the most common form of WLS for both adults and teens. It involves making the stomach much smaller and attaching it to a lower section of the intestine, bypassing a short segment of intestine and most of the stomach. This limits the amount of food that can be eaten at one time and prevents the body from absorbing as much of the nutrients in each meal. The removed part of the stomach and intestine are left inside the body so they stay “alive” just in case the procedure must be reversed.
Gastric Banding (Lap-Band)
A medical device in the shape of a fluid-filled silicone band is fitted around the stomach leaving only a small pouch just below the esophagus to hold food during a meal. The opening down into the rest of the stomach is squeezed down very small so food takes a while to pass through. A tube goes from the band to a port just under the skin so the amount of fluid in the band can be adjusted as needed. A gastric band is the only readily reversible form of teen WLS, but it is intended to be a permanent way to support healthy eating.
Vertical Gastric Sleeve (Vertical Sleeve Gastrectomy or VSG)
In this surgery, about 75 to 80 percent of the stomach is completely removed. The remaining portion of the stomach is the shape of a tube or sleeve. Food fills up this new, small stomach very fast and makes patients feel full longer after each meal. This procedure is not reversible. However, since it has less of a risk for malnutrition than gastric bypass, some bariatric surgeons prefer this approach for teens.
Who Is a Candidate for Teen WLS?
Patients must be finished with puberty to be candidates for any weight-loss surgery. Ideally, they have also achieved most of their adult height (these patients are usually 14 or older). Teens who are candidates for WLS are those who have been very obese for at least a few years. Many have struggled with obesity since early childhood. They are usually at least 100 pounds overweight with a BMI of 40 or a BMI of at least 35 with one or more serious medical conditions that could be helped by weight-loss surgery.
Like adult patients, teens must show that they have tried without success to lose weight with diet and exercise and through a medical weight loss program including behavioral modification. They may need to lose some preliminary weight and meet certain physical fitness requirements before being approved for surgery. This helps ensure they are willing and able to follow through with post-surgical regimen for diet and exercise.
It Takes a Family to Help a Teen Lose Weight
Patients and their families go through counseling so that everyone involved fully understand the risks and benefits of the procedure as well as the lifestyle changes needed to create a good outcome. Teens must have a solid support system at home to be considered for this procedure. Often, parents and other family members need to make changes of their own to eat better so they can provide the right home environment for their teen after WLS.
The assessment period is lengthy, taking anywhere from a few months to a year. Pediatric patients may be kids, but they are considering a very grown-up decision that will impact the rest of their life. Fortunately, that’s a life they may be able to live without the complications caused by Type 2 diabetes, high blood pressure, inflamed liver, sleep apnea and other obesity related complications. Teen bariatric surgery has been shown to be effective for reducing or eliminating each of these health problems, giving young people a better start in life.